title: The long-term complications of percutaneous dilatational tracheostomy.
abstract: Percutaneous dilatational tracheostomy was adopted at our institution, because it was demonstrated to be more cost effective than standard open tracheostomy in critically ill patients. The objective of this study was to evaluate the long-term outcome and complication rate of percutaneous dilatational tracheostomy in critically ill patients. We performed a consecutive case study of all Level I trauma patients from August 1991 to May 1994 who underwent percutaneous dilatational tracheostomy. All patients were prospectively evaluated by a standard questionnaire a minimum of 1 year after the procedure. All symptomatic patients were offered fiberoptic laryngoscopy. Descriptive statistical methods and the Student's T test were used to analyze the data. Of 7054 consecutive trauma admissions, 237 tracheostomies were performed. A total of 143 tracheostomies (60%) were open, and 95 (40%) were percutaneous. Of the 95 patients, 20 were lost to follow-up, 12 died from causes unrelated to the procedure, 6 had severe traumatic brain injuries and were unable to participate, and 2 patients required conversion to an open procedure. This left a study group of 55 patients. At a minimum of 1 year follow-up, 40 patients (73%) were asymptomatic. Of the 15 (27%) symptomatic patients, two patients had acute airway compromise after decannulation secondary to subglottic stenosis. Both were recannulated and subsequently decannulated uneventfully. Six patients declined fiberoptic laryngoscopy, because their symptoms were minimal (minor voice changes in three and intermittent hoarseness in three). Nine patients underwent fiberoptic laryngoscopy, and all examinations were normal. The mean cost of standard open tracheostomy at our institution is $1134 (58%) more than the mean cost of percutaneous dilatational tracheostomy. Of the study group patients undergoing percutaneous dilatational tracheostomy, 27 per cent complained of symptoms a minimum of 1 year posttracheostomy. Of these patients, 60 per cent underwent fiberoptic laryngoscopy, and no subglottic lesions were identified. Our findings suggest that percutaneous dilatational tracheostomy is a safe, cost-effective alternative to standard tracheostomy in critically ill patients.
authors.affiliation: Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Rosenbower
authors.forename: J A
authors.initials: JA
authors.lastname: Morris
authors.forename: V A
authors.initials: VA
authors.lastname: Eddy
authors.forename: W R
authors.initials: WR
authors.lastname: Ries
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D016638:Critical Illness / Q000628:therapy*; D004106:Dilatation; D004646:Emphysema / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology; D012121:Respiration, Artificial; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects* / Q000191:economics / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000628:therapy*